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Major Depression

Major Depression

Christopher Reist (Academic Psychiatrist, Co-Author of “Psychiatry”) gives expert video advice on: How do I know if I need treatment for depression?; What are common treatments for depression?; Can I prevent my sadness from developing into depression? and more...

What is a "mood disorder"?

Mood disorder refers to a number of specific mental illnesses that are characterized by certain mood states. For example, major depression is comprised of episodes of depression -- of serious depression. <a href="http://www.videojug.com/interview/bipolar-disorder">Bipolar disease</a>, in contrast, is comprised by episodes of both depression as well as mania or hypomania, which are two kinds of euphoric mood states.

What is "major depression"?

Depression, or what is also referred to as major depression, is a psychiatric disorder that's characterized by a persistently depressed mood along with a number of key features. These key features include: problems with sleep, difficulties with concentration and irritability. Major depression is also characterized by something called anhedonia, which is the inability to derive pleasure from things that are typically enjoyed, such as hobbies, sexual activity or even meals. People with major depression will often show changes in weight, have trouble with general motivation, have lethargy and find it difficult to start new activities. This all comes together to cause impairment in social functioning as well as ability to work.

What is the difference between "sadness" and "depression"?

The terms depression and sadness can be confusing, and some people use them interchangably, however there are important distinctions. Sadness is really a universal phenomenon; everyone can relate to what being sad is like. However, depression really refers to something more profound. In Psychiatry, when we talk about a person being depressed, we are not only talking about a mood state, but we're also talking about physical symptoms, such as problems with sleep, appetite, the ability to enjoy things. We also see other characteristic things such as worthlessness and hopelessness, which we don't see typically when a person is just experiencing a sadness.

What are the most common causes of depression?

We really don't understand what causes depression. We certainly know that there is a significant genetic basis. If you look at family histories we see that if you have a first degree relative who suffered from depression or another mood disorder, it puts you at risk for developing depression yourself. There are ties between developing depression and stressful life situations such as loss of a loved one or other kind of trauma; however, it's difficult for us to really tie those together tightly. There are other cases where we don't really see any genetic history or life event that would explain the development of depression. We can only surmise that this is something going on in the brain that we don't have any understanding of.

What are the most common dangers associated with depression?

The most important danger in major depression is suicide. Approximately 15% of patients with depression will commit suicide. This amounts to over 3, deaths in the United States each year. Other dangers of depression are the consequences of impairment in social and occupational functioning. Untreated depression can lead to loss of family, divorce, estrangement from friends; and in the workplace, it can lead to loss of job. When these things all happen, a person's life can go into a spiral, and result in significant impairment. Another danger of depression is the development of substance abuse. Sometimes patients who have symptoms of depression will turn to alcohol or other drugs, which will only complicate the situation. A final danger is that depressed patients often don't take care of other important health needs. For example, if a patient has a chronic illness like hypertension or diabetes, we find that, when they're depressed, they don't look after those illnesses. So, depression can really complicate a person's overall health.

How will a psychiatrist determine whether I am clinically depressed?

There are not specific psychiatric tests for determining clinical depression. The clincal depression diagnosis is based on the collection of information during psychiatric interviews, information based on a patient's family history and, if applicable, prior psychiatric treatment. Sometimes there are tools, such as different rating scales that can help the psychiatrist assess various symptoms in a systematic way in order to determine possible clinical depression, but this is just another aspect of the overall data that is considered.

What are common treatments for depression?

The most common treatment for major depression is the use of anti-depressants. There are a whole collection of anti-depressants, and most commonly patients will be started with medications called SSRI's or Selective Serotonin Reuptake Inhibitors to treat their depression. However, each psychiatrist has at his or her disposal as many as 1 to 15 other alternative depression treatments if SSRI's don't work. Psychotherapy is an important part of treatment and the vast majority of positive outcomes are cases where patients receive both treatments for their depression.

Who is most at risk for developing depression?

People most at risk from developing depression are people who have had a prior depression episode. We find that with each successive episode of depression the likelihood of a future episode increases. If a person has had two episodes of depression, it's almost guaranteed that they'll develop another one at some point in their life. If you have a positive family history with regards to depression, substance abuse or other mood disorders, your risk is increased. People who are experiencing severe stress for example, from a traumatic event or loss of a spouse or loved one are also at risk from depression. There are certain medical conditions such as heart attacks, strokes and chronic pain that also increases an individualss risk for developing depression. Also, the risk of developing depression is twice as high in women as it is in men.